Individual Application Form

Name

Title

Company/Business

Website

Address

Address Line 2

City

State

Zip Code

Phone

Which Lake 100 Member Recruited you ?

Do you reside in Lake County ?

Yes No

Are you employed

Yes No

Do you own a business in Lake County ?

Yes No

How many years have you had Lake County associations?

List your Lake County community service:

What do you hop to gain from being a member of Lake 100 ?

Do you have any concerns regarding economic development in Lake County?

Do you have any special interests or skills that could assist Lake 100 in furthering its mission?

Do you have the ability to consistently attend our monthly lunch meetings (9 meetings / year required)?

Yes No

The cost is $750 annually; this includes your monthly lunches. Please make checks payable to Lake 100. Members may attend all meetings and activities associated with Lake 100 with full participation and input, but voting rights remain with the Lake 100 Board of Directors. Future Directors are nominated from the membership

Individual Application Form

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